A field marketing organization (FMO) specializing in the senior insurance market
ManhattanLife Insurance and Annuity Corporation will discontinue new sales of Medicare Supplement plans. The company will no longer be accepting any new business effective April 30, 2025. This will be for all states, but will not affect existing Medicare Supplement policyholders. All in-force policies will continue to be serviced as usual.
Any application received in their home office after April 30th will NOT be processed and will be withdrawn.
Virginia has joined several other states in enhancing Medicare protections for seniors by adopting the Medicare birthday rule. The legislation marks a significant shift in how Virginia residents can manage their Medicare Supplement insurance, commonly known as Medigap policies.
In early 2025, Virginia lawmakers introduced legislation to create an annual enrollment opportunity for Medicare Supplement policyholders. The proposal aimed to provide greater flexibility for seniors seeking to change their coverage, particularly those who might be paying excessive premiums or needing different benefits.
The journey of Virginia’s birthday rule legislation through the state legislature reveals the careful consideration given to this policy change. Initially, the bill was introduced as HB 64 by Delegate Ellen H. Campbell 1. This proposal followed similar legislative efforts in other states, establishing what policy experts refer to as a “birthday rule” for Medicare Supplement policies.
The legislative process included significant debate about the bill’s specific provisions. As with many healthcare-related bills, various stakeholders provided input that shaped the final legislation. The National Association of Benefits and Insurance Professionals (NABIP) Virginia chapter played a notable role in the discussions, sharing expertise on potential challenges with birthday rule implementation 2.
Throughout the legislative journey, the bill underwent several modifications. One crucial change involved the language regarding what types of plans enrollees could switch to during their birthday period. The original bill language allowed for switching to plans offering “the same benefits as or lesser benefits than” current coverage 1. However, at some point during the legislative process, lawmakers modified this language by removing the word “lesser” 3.
The significance of this change was substantial. Without the “lesser” language, the bill would technically not allow beneficiaries to downgrade their plans (such as moving from Plan F to Plan G, or Plan G to Plan N) to save money 3. Nevertheless, the bill continued to move forward through the legislative chambers.
Interestingly, this was not the only birthday rule legislation introduced in Virginia’s 2025 legislative session. According to MedicareResources.org, a second bill was introduced that would allow enrollees to switch to any other plan of equal or lesser benefits, and this alternative bill was approved by the state House in early February 2025 4. This indicates the level of interest among Virginia lawmakers in providing this type of protection for Medicare beneficiaries.
The path to passage wasn’t entirely smooth. Some legislative sources suggested that birthday rule legislation might face challenges. According to NABIP reports, after discussions with the bill’s sponsor during their advocacy day, “much of the initial support for the bill was lost” 2. These same sources indicated the possibility that the birthday rule language might be considered a “basket bill” – legislation that leadership distributes to freshman members to give them bills to sponsor and potentially provide an easy early victory 2.
Despite these potential hurdles, the legislature ultimately approved the birthday rule legislation, demonstrating Virginia’s commitment to expanding healthcare options for seniors.
The final version of Virginia’s Medicare birthday rule includes several important provisions that will directly impact Medicare beneficiaries throughout the Commonwealth:
This notification requirement represents an important safeguard, ensuring that beneficiaries are aware of their opportunities to make coverage changes. It places the responsibility on insurance companies to proactively inform their customers about this annual right.
The provisions in Virginia’s birthday rule are similar to those implemented in other states but contain some specific elements tailored to Virginia’s insurance market and regulatory framework. As of June 2024, nine other states had enacted some type of Medigap birthday rule: California, Idaho, Illinois, Kentucky, Louisiana, Maryland, Nevada, Oklahoma, and Oregon 5. Each state’s implementation varies in terms of the enrollment window length, carrier-switching options, and coverage change limitations.
For instance, the window in Idaho extends 63 days after a beneficiary’s birthday, while in Maryland it lasts only 30 days 5. Some states also have age limitations, such as Illinois, which only allows the birthday rule up to and including age 75 5. Virginia’s 30-day window places it in line with several other states’ policies.
It’s worth noting that the birthday rule differs significantly from Medicare’s standard enrollment periods. The typical Medicare Annual Enrollment Period runs from October 15 to December 7 each year 6, while the Medicare Advantage Open Enrollment Period operates from January 1 through March 31 7. Unlike these fixed calendar periods, the birthday rule creates a personalized enrollment window tied to each beneficiary’s birth date.
Furthermore, the birthday rule only applies to individuals who already carry a Medigap plan, making it a tool for plan switching rather than initial enrollment 5. This distinguishes it from initial enrollment periods and makes it particularly valuable for long-term Medicare beneficiaries who may have changing healthcare needs or financial situations.
Virginia’s adoption of the birthday rule places it among a growing number of states recognizing the need for greater Medicare Supplement flexibility. The rule’s provisions work alongside other Medicare enrollment periods, giving Virginia seniors multiple opportunities throughout the year to optimize their healthcare coverage.
In addition to the birthday rule provisions, Virginia has recently expanded other Medicare protections. Effective January 1, 2024, Virginia law established a new six-month open enrollment period for individuals under age 65 who are Medicare-eligible due to End-Stage Renal Disease (ESRD) 8. This earlier policy change ensured that these vulnerable individuals could access Medigap coverage without medical underwriting or pre-existing condition limitations, provided they had at least six months of continuous creditable coverage 8.
Another important protection implemented alongside that 2024 change was the requirement that premium rates for Medicare-eligible individuals under 65 cannot be higher than rates charged to Medicare-eligible individuals aged 65 for the same plan 8. This rate protection ensures that younger Medicare beneficiaries with disabilities don’t face discriminatory pricing.
Together with these earlier protections, the new birthday rule creates a more comprehensive framework of Medicare Supplement options for Virginia residents.
The Medicare birthday rule in Virginia will take effect on July 1, 2025 3. This implementation date gives insurance companies, beneficiaries, and regulatory agencies several months to prepare for the new policy.
The timeline for implementation includes several key milestones:
For Virginia residents with birthdays in July, they will be among the first beneficiaries eligible to utilize this new enrollment opportunity. Those with birthdays later in the year will have their respective 30-day windows beginning on their birthdays.
The legislation’s effective date means that insurance companies offering Medicare Supplement policies in Virginia must be prepared to:
Prior to the birthday rule’s implementation, Virginians with Medicare Supplement policies faced more limited options if they wanted to change their coverage outside their initial Medigap open enrollment period. Without guaranteed issue rights, many would need to go through medical underwriting, a process where insurance companies review health history and may charge higher premiums or deny coverage based on pre-existing conditions.
The July implementation date aligns with the start of Virginia’s fiscal year, a common effective date for new legislation in the Commonwealth. This timing provides a clean transition point for regulatory agencies and insurance providers.
It’s important for Medicare beneficiaries to understand that the birthday rule does not replace or override other Medicare enrollment periods. The standard Medicare Annual Enrollment Period (October 15-December 7) 6 and Medicare Advantage Open Enrollment Period (January 1-March 31) 7 will continue to operate alongside the new birthday rule. However, while these standard periods allow changes between Original Medicare and Medicare Advantage plans, the birthday rule specifically addresses Medicare Supplement policies only.
The effective date of July 1, 2025, demonstrates the legislature’s intent to implement this consumer protection promptly while still allowing sufficient preparation time. This balance suggests careful consideration of both beneficiary needs and industry implementation requirements.
For Virginia Medicare beneficiaries, particularly those paying high premiums or experiencing changes in healthcare needs, the upcoming implementation represents a valuable new opportunity to optimize their coverage. Furthermore, the notification requirements ensure that beneficiaries will receive timely reminders about their rights under the new law.
The birthday rule’s implementation follows a national trend of expanding Medigap enrollment opportunities beyond the traditional once-in-a-lifetime initial enrollment period. While federal regulations establish minimum standards for Medicare Supplement policies, states have increasingly taken action to provide additional consumer protections and enrollment rights through mechanisms like the birthday rule.
Virginia’s adoption of this policy places it among states recognizing that healthcare needs and financial circumstances change over time, and that seniors deserve regular opportunities to reassess and adjust their Medicare Supplement coverage accordingly.
The following states have already implemented the ‘birthday rule’:
California
Starting from the first day of your birth month, California residents are granted a 60-day window to switch to another Medigap plan that offers either identical or reduced benefits. This timeframe also allows for switching to a different insurance company. This extended opportunity became effective on January 1, 2020, replacing the previous 30-day limit that was in place before that date.
Idaho
In Idaho, beneficiaries have 63 days from their birthday to make a change to another Medigap plan, as long as the new plan matches or lowers the benefits of the current plan. The rule also permits enrollees to change insurance providers. This birthday-related enrollment period began on March 1, 2022.
Illinois
Illinois residents between the ages of 65 and 75 are eligible for a 45-day period starting on their birthday during which they may transition to another Medigap policy that offers the same or fewer benefits. However, this only applies to plans offered by their current insurer or an affiliated company—a provision added through legislation passed in 2024. The rule has been in effect since January 1, 2022.
Maryland
In Maryland, Medicare beneficiaries have a 30-day window following their birthday to switch to a Medigap plan that is either equivalent in coverage or less comprehensive than their current plan. This regulation took effect on July 1, 2023.
Oregon
Oregon’s birthday rule provides a 30-day period beginning on the first day of the beneficiary’s birth month. During this time, enrollees can change to a Medigap plan offering the same or reduced coverage and can also change insurance carriers. This long-standing rule has been active since January 1, 2013.
Nevada
Nevada follows a similar approach to California and Oregon, granting residents 60 days starting from the first day of their birth month to switch to another Medigap plan with equal or lesser benefits. Insurance carriers can also be changed during this period. This policy took effect on January 1, 2022.
Louisiana
In Louisiana, beneficiaries are given 63 days from their birthday to switch to another Medigap plan that provides the same or fewer benefits. However, this option is limited to plans offered by the current insurer or its affiliated companies. These provisions became official following legislation passed in 2023.
Kentucky
As of January 1, 2024, Kentucky law permits Medigap enrollees to switch to an equivalent plan offered by a different insurer. This switch must be made within 60 days of the enrollee’s birthday, and the new plan must provide the same level of benefits as the existing one.
– https://legacylis.virginia.gov/cgi-bin/legp604.exe?241+sum+HB64
– https://nabip.org/media/9785/state-update-quarterly-report-10-24.pdf
– https://www.reddit.com/r/medicare/comments/1jjkhn2/governor_just_signed_the_medicare_birthday_rule/
– https://www.medicareresources.org/medicare-eligibility-and-enrollment/the-birthday-rule-a-gift-to-medigap-enrollees/
– https://wtop.com/news/2024/06/what-is-the-medigap-birthday-rule-and-which-states-have-it/
– https://www.cms.gov/priorities/key-initiatives/medicare-open-enrollment-partner-resources
– https://www.vmfh.org/our-services/wellness-resources/medicare-resources/medicare-enrollment-periods
– https://www.scc.virginia.gov/consumers/insurance/health-insurance-consumer/tips,-guides-publications/virginia-medigap-guide/
Contest Dates: 02/24/2025 – 04/30/2025
For complete rules download the contest flyer
UPDATE: CMS has rescinded the decision to force Medicare beneficiaries to contact CMS directly to enroll in a Medicare Advantage plan using the FEMA Special Enrollment Period.
Medicare Advantage enrollment changes will negative impact both consumers and agents!
We are spilling the beans on a super important shift from Medicare (CMS), and guess what? It’s no longer a maybe—it’s locked in. They sealed the deal on this ruling at 2024’s tail end, and once we hit April 1st, 2025, it’s going to shake things up for folks selling Medicare Advantage.
Medicare salespeople used to have a helping hand for their customers when terrible weather or other disasters threw a wrench in sign-up plans, all thanks to the FEMA Special Enrollment Period (SCP). But a few shady characters took advantage of this shortcut. Well, that’s all in the past—wave goodbye to that special enrollment period.
Come April 1st, to sign up for FEMA SCP, beneficiaries need to contact Medicare and do it on their own. Agents won’t get paid for helping with this anymore.
Okay let’s keep it to 3 bullet points—this is going to be a real headache for the older folks.
This mix-up makes things chaotic for customers and representatives alike—all due to a few folks who decided not to follow the current regulations. When these agents (many times they are in call-centers) take these shortcuts, it ruins it for everyone.
Yes, we get that CMS guidelines shift all the time—it’s akin to aiming at a moving bullseye. Whenever you’re in doubt concerning a policy, reach out to us! Helping with this stuff is part of what our marketing crew’s job is.
As 2025 moves along we will start hearing about proposed rules for 2026. Make sure your clients don’t get all twisted up by the chit-chat from politicos or those big flashy campaign vows.
Look older folks tune into the news, right? And those politicians? Man, they throw around big claims like it’s nothing especially when votes are on the line. You remember Bernie Sanders yapping about tossing dental benefits into Medicare? People are still thinking that’s the real deal and they are already available. Or how about President Trump throwing around the idea of cutting out taxes on Social Security? Yeah, it’s just an idea, but all of a sudden you are getting a bunch of calls from your clients asking about this.
Let’s face it…you already get enough calls about the constant “free money” rumors.
Here are just a few that drive us crazy:
And don’t even get me started on the constant buzz about That “$5,000 grocery card” you heard about? Yeah, it’s not real.
What’s super smart is to keep learning. You must be able to tell apart what’s true and what’s made up when you’re chatting with your customers. The reality is that there is so much misinformation floating around on the internet that our job description now includes being a B.S. Detector.
Always remember that you are not doing this alone. Whether it’s a rule change such as Medicare Advantage enrollment changes or you need to learn how to cross-sell ancillary products we are always just a click or phone call away!
As we step into 2025, Medicare is unveiling significant updates that could directly impact how beneficiaries manage their healthcare. From cost adjustments to expanded benefits and plan options, staying informed is vital—especially for those guiding clients through these important decisions. Here’s a breakdown of what’s new and noteworthy in Medicare for 2025.
Expect to see an increase in Medicare Part B costs this year. The standard monthly premium rises to $185 (up $10.30 from 2024), while the deductible grows to $257, a $17 jump. For the approximately 8% of beneficiaries with higher incomes, premiums range between $259 and $628.90.
Costs related to Medicare Part A are also seeing changes. Here’s a snapshot:
Most beneficiaries don’t pay a Part A premium, but those with limited work history should note the increases.
Medicare Advantage continues to grow in popularity, with enrollment projected to surpass 36 million beneficiaries, representing 60% of Medicare users. Though the total number of plans is slightly reduced, here’s what’s trending:
With these updates come new compliance requirements and market trends:
Agents play an increasingly important role in navigating these changes, ensuring clients make informed decisions about their healthcare.
Medicare’s 2025 updates underscore the importance of staying proactive. Whether it’s understanding cost changes, navigating new plan options, or maximizing benefits, there’s plenty to consider. By keeping abreast of these developments, you’ll not only guide clients effectively but also strengthen trust and credibility in the process.
The Scope of Appointment (SOA) is crucial for Medicare agents, ensuring transparency and compliance with regulations when discussing Medicare Advantage and Part D plans. With the recent return of the 48-hour rule in 2024, it’s essential for agents to be up-to-date on SOA requirements to stay compliant and maintain professionalism.
An SOA is a mandated document that outlines what will be discussed between an agent and a Medicare beneficiary during an appointment. This ensures that both parties agree on the topics and prevents unauthorized sales pitches. It applies primarily to Medicare Advantage and Part D prescription drug plans, serving as a protective measure for consumers.
Utilizing technology platforms like AgencyBloc simplifies SOA management. This software allows agents to send, track, and store SOAs efficiently, with options for email or text communication. This approach not only meets compliance standards but also enhances client interaction by ensuring secure data handling.
To maintain transparency, agents should educate clients about the SOA process through various channels such as emails, newsletters, or personalized consultations. This proactive communication helps establish trust and ensures clients understand the importance of the SOA.
Staying compliant with SOA requirements is vital for Medicare agents. Embracing technology and clear communication will help agents manage SOAs efficiently and build trust with clients. By adhering to these guidelines, agents can ensure a smooth and ethical sales process.